Benefit and risk of adding rivaroxaban in patients with coronary artery disease: A systematic review and meta‐analysis

Abstract

BackgroundAlthough the European Medicines Agency and the US Food and Drug Administration have, respectively, approved rivaroxaban for the prevention of recurrent major adverse cardiovascular events in patients with myocardial infarction and stable coronary artery disease, its efficacy and safety is unclear. This meta‐analysis aimed to evaluate the benefit and risk of adding rivaroxaban in coronary artery disease (CAD) patients, focusing on treatment effects stratified by different baseline clinical presentations.HypothesisThere are differences in treatment effects of adding rivaroxaban among CAD patients with different baseline clinical presentations.MethodsMedline, EMBASE, and Cochrane Databases were systematically searched from inception to 21 July 2020 for randomized controlled trials (RCTs) comparing rivaroxaban in CAD patients. The primary efficacy endpoint and safety endpoint were assessed by using Mantel–Haenszel pooled risk ratios (RRs) and 95% confidence intervals (CIs).ResultsFive RCTs that included 43 650 patients were identified. Patients receiving rivaroxaban had a significantly lower risk of the primary efficacy endpoint (RR, 0.86; 95% CI, 0.76–0.97, p = .01) accompanied by increased risk of the primary safety endpoint (RR, 1.83; 95% CI, 1.10–3.05, p = .02). Subgroup analyses showed that in males the risk–benefit appears to be more favorable while in patients ≥65 years, in females, in patients with diabetes, those with mild to moderate impaired renal function, and region of Asia/other seems unfavorable.ConclusionRivaroxaban may provide an additional choice for secondary prevention in CAD patients. However, careful estimation of the risk of ischemic and bleeding events using patient characteristics are critical to achieving net benefit.

Rivaroxaban: Expanded Role in Cardiovascular Disease Management—A Literature Review

“…In the systematic review and meta-analysis on the use of rivaroxaban in coronary artery disease, it was concluded that patient's characteristics of ischemic and bleeding risk are critical in deciding about the addition of rivaroxaban [ 40 ]. The low-dose rivaroxaban in peripheral arterial disease was studied in the systematic review of randomized trials, and it was found to be effective in preventing cardiovascular events with a possible increase risk of bleeding [ 41 ].…”

“…Therapeutic dose of rivaroxaban was studied in SELECT-D (Anticoagulation Therapy in Selected Cancer Patients at Risk of Recurrence of Venous Thromboembolism), a randomized, multicenter pilot trial, and was compared to the therapeutic dose of dalteparin in patients with active cancer and diagnosis of VTE. There was less cumulative VTE recurrence in the rivaroxaban group compared to the dalteparin group [ 40 ]. Based on this trial, it was concluded that rivaroxaban at standard DVT/PE dosage could be considered in patients with active cancer and diagnosis of VTE after shared decision making.…”

The effect of rivaroxaban low doses on the stable angina of the II–III functional class clinical manifestations and the quality of life in patients with ischemic heart disease

“…Одним из недавних ярких достижений кардиологии стало обоснование нового подхода к антитромботической терапии, при котором АСК сочетают с низкими дозами ингибитора фактора Ха -ривароксабана. Высокий терапевтический потенциал этой комбинации доказан в крупных исследованиях [4][5][6] и уже отражен в международных и отечественных рекомендациях [1,2].…”

Determination of rivaroxaban in rat plasma by ultra‐high‐performance liquid chromatography–Q‐Orbitrap high‐resolution mass spectrometry and its application to a pharmacokinetic study

“…It is also often used for the prevention and treatment of thromboembolic disorders such as deep vein thrombosis, pulmonary embolism, peripheral artery disease (Bauersachs et al, 2020; Bonaca et al, 2020; Cohen et al, 2020; Schastlivtsev et al, 2019; Simmons et al, 2018; Wang et al, 2021). Therapeutic drug monitoring is critical to decrease the incidence rate of bleeding and thrombosis for personalized treatment with rivaroxaban, especially for drug interaction treatment, patients with renal dysfunction, elderly patients, patients with cardiovascular problems, and so on (Atarashi et al, 2021; Willmann et al, 2021; Xie et al, 2021; Zhang et al, 2021). In addition, an accurate analytical method is necessary for therapeutic drug monitoring.…”

“…. Therapeutic drug monitoring is critical to decrease the incidence rate of bleeding and thrombosis for personalized treatment with rivaroxaban, especially for drug interaction treatment, patients with renal dysfunction, elderly patients, patients with cardiovascular problems, and so on (Atarashi et al, 2021;Willmann et al, 2021;Xie et al, 2021;Zhang et al, 2021). In addition, an accurate analytical method is necessary for therapeutic drug monitoring.…”